Provider Demographics
NPI:1518412881
Name:DAVYDOVSKAYA, ANASTASIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:DAVYDOVSKAYA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33075 WAGON WHEEL DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2346
Mailing Address - Country:US
Mailing Address - Phone:440-554-2958
Mailing Address - Fax:
Practice Address - Street 1:20485 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1456
Practice Address - Country:US
Practice Address - Phone:216-531-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03334784183500000X
TX59143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist